15040121 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20632 CHERYL DR CONTRACTOR:ZL CONSTRUCTION CO PERMIT NO:15040121
OWNER'S NAME:
WALNUT CREEK,CA 94598 PHONE NO:(925)899-5704
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
OR 0 3 2� DEMO(E)SWIMMING POOL&FILL TO 90%
License Class Lic.# ZJ`l COMPACTION
77 FOR FUTURE BUILDING
Contractor C11" Daet I b ! f
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
P�rmance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$4500
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:35916023.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 D + PE SSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save O ALLED INSPEC ION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the 7 `
granting of this permit. Additionally,the applicant understands and will comply Issue ate:
with all non-point s e re lations per the Cupertino Municipal Code,Section
9 18.
!� r RE-ROOFS:
Signatu Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the B a Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the upert" o Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code, 25534.
Section 3700 of the Labor Code,for the performance of the work for which this j s
permit is issued. Owner or authorized agent: Date:
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I ��STRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
918.
Signature Date
CITY OF CUPERTINO D
JigFEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20632 CHERYL DR DATE: 04/16/2015 REVIEWED BY: MELISSA
APN: 359 16 023 BP#: *VALUATION: $4,500
*PERMIT TYPE: Demolition Permit PIAN(YIEC K TYPE:
PRIMARY PENTAMATION
USE: Swimming Pool, Res. PERMIT TYPE: 1SFP00LDE
WORK DEMO E SWIMMING POOL& FILL TO 90% COMPACTION FOR FUTURE BUILDING
SCOPE
FEE ID #POOLS
1 DEMOPRES 'I
WIN SENT
I W- 1
7 a rc� aha ht 4' 1
Vfec:h. Ulan Ch<:ck Phimb, Ilam('heck Elec,flan t;h ck
t li>-cla. Permit 1'ctc>; Phimb.Permit f ee: f`lec.Permit t <e:
Ocher Zllech.Insp. Other Plumb Insp. Other faec.Insp. EIF
Alech.InspFee: Plumb. hisp.Fee: I-, x.Insp. Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Theseees are based on the relimina information available and are onlyan estimate. Contact the Det or addn7 info.
FEE ITEMS(Fee Resolution 11-053 E,f' 711/131 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. N.-Fee
Plurnh.11lech.lElec
Permit Fee: $329.00
Suppl. Insp.Fee-.0 Reg. ® OT0 0 hrs $0.00
�'lu�nf�.;��feclz./1'l�c•
Plurnla.i.l9ech.iElec T ern it Fere:
Construction Tax:
.dininistr aftive Fe€:
rf"ork Without Permit>
Advanced 1'lc'aa'ar ing Fees:
TrUvel Documentation Fees_ �
Strom Motion Fee: IBSEISMICR $0.59 Select an Administrative Item
Bldg,Stds Commission.Fee: 1BCBSC $1.00
$330.59 $0.00 $330.59
Revised: 04/01/2015